On Thursday, June 28, 2012, the Supreme Court ruled on the constitutionality of the Patient Protection and Affordable Care Act (PPACA or ACA for short). In the ruling of a lifetime (really, how often do non-constitutional scholars get this excited about anything involving the Supreme Court?), the Court upheld the entire law as constitutional, aka, legal. The details were very exciting, but I won’t get into them here. That’s not what this post is about.

This post is about the fact that certain segments of society have taken up the most selfish, bigoted, irresponsible, opportunistic, and ignorant views on this subject that it makes me embarrassed to call them fellow citizens. It is one thing to disagree with the nuances of the law. I certainly don’t think the law is perfect as is. I would even understand if people openly stated that they don’t care about other people and don’t want to pay for them. At least they’re being honest. It’s quite another to brandish your argument in fancy words and pretend you’re all about cost control, “freedom”, and “judicial restraint”. While I’m probably preaching to the choir, and it’s not like my blog post will reach Cantor and Co., I feel compelled to spell out two arguments for the necessity of health reform.

The moral argument: You’ve heard the statistics. 50 million people are uninsured in America. That’s nearly 1 in 6. Those who are insured may be underinsured, or may take a job or remain at a job because they need the healthcare provided by their employer. Pre-“Obamacare”: Lifetime caps on coverage were instituted, making it impossible for many people to pay their medical bills, medicines were more expensive, contraception cost more money, those with preexisting conditions such as breast cancer (yes, really) were routinely denied coverage altogether, and there were gaping holes in insurance coverage for young adults and rising costs for senior citizens. Nearly 50,000 people a year die because they don’t have health insurance. This is a staggering number and should be unacceptable to any human being. The United States, an industrialized country, and the wealthiest country in the world by far, has no excuse. Politicians love to brag about how the American medical system has the finest doctors and the best technology in the world. Yet, we charge people exorbitant amounts at the emergency room, and let tens of thousands die per year. It’s often said that reason is the better tack to take in an argument as opposed to emotion. In this case, there’s no way to leave emotion out of it. Sickness and suffering is an emotional thing—especially if much of this suffering can be alleviated, and care can be provided for all.

The economic argument: For those who don’t care about the morality of the matter—or who have compassion, but “don’t think we can afford” to overhaul the healthcare system right now—there is a very strong economic argument to be made. Currently, healthcare accounts for 18% of the country’s GDP. To put that number in perspective, the United States government spent approximately 1% of GDP on the space program at the height of the Cold War, and that was a lot of money. This 18% is not stagnant, either. When people say that healthcare costs are “spiraling out of control”, and need to be contained, they mean it. Healthcare will eat up more and more of the budget, and soon, we won’t be able to pay for anything else. This is not meant as a scare tactic, and it’s not wild speculation. It’s the truth. Insuring more people, providing preventative care, preempting emergency room visits (the only way some people get treated), neutralizing risk, and creating a climate of stability will bring the costs down significantly. Sure, it will take a few years, but inaction is worse. If the U.S. had taken significant action on climate change decades ago…but I digress. Doctors, hospitals, patients, and healthcare experts all agree that the fiscally responsible thing to do is to go the way of the ACA.

The free rider problem: This is about who we are, as Americans, as a society. Like it or not, we do live in a society, and this concept carries with it certain responsibilities. Given the choice, individuals will act in self interest, aka, not take care of someone else. People will also not pay for things they don’t want or don’t see a need for—or, especially, if they feel the “intrusive” government is “shoving it down their throats”. Unless that something is on an infomercial…maybe the government should’ve tried to selling healthcare reform on TV at 3 in the morning. The point is, people need to be mandated to buy insurance to neutralize risk and to control costs for everyone. There needs to be a penalty for noncompliance to ensure people participate and that the program is successful. Also, it’s not as if people never get sick or hurt or old. It’s really an investment. Many of the people who don’t want to buy health insurance are the people who end up needing it the most. Those who can’t afford it will be aided. We live in a society in which cooperation is key. No one lives in a vacuum and became successful or self sufficient by himself or herself. A real patriot would want to do what’s best for the people in his or her country. Any person who wants to live in a successful society—really just an outgrowth of the idea of favorable environment—should understand and internalize this fact. We need to work together in a society, and sorry, Ron Paul, libertarian tendencies of hoping the “members of a church” will help someone in their community who is sick is unrealistic, unpredictable, and unsustainable.

In the 2 years and 3 months since the Patient Protection and Affordable Care Act passed, it seems all Republicans have been doing is mounting a relentless P.R. campaign against the “monstrosity” they call “Obamacare”. When the scare tactics of alleged “death panels” didn’t catch on much beyond Tea Party circles, Republicans aimed for greater legitimacy by claiming that the ACA was unconstitutional. Eventually 26 states advanced this charge, and the healthcare law made it before the Supreme Court. In reality, behind the scenes much debate was going on within the Republican Party. In the last few months, talking points started to shift from “gutting the whole thing” to “of course, we’d keep the most popular parts”. While “replace and replace” became the de facto sound bite for any politician with an “R” attached to his or her name, the issue of what to replace their dreaded Obamacare with became more real. The sobering reality, once the Supreme Court heard arguments for and against the constitutionality of the law in March, was that the Republicans must provide a viable alternative to the “2,700 page” legislation they had worked so tirelessly to strike down.

Herein lies the issue. As many have observed, prominent Republicans seemed to want to keep many parts of the law that proved popular. Their main opposition (beyond some of the issues with women’s health coverage and other so-called “liberal” provisions) was to the individual mandate part of the law. They didn’t like the loss of freedom imposed by a mandate forcing people to pay for healthcare. Their claims about the mandate, like all of their other claims about the law, were, of course, greatly exaggerated and distorted. Hyperbolic or not, Republicans didn’t like the idea of a penalty and infringement on individuals’ all-important “liberty”.

Cue the free rider problem. Also, isn’t denying people healthcare coverage an infringement of their liberty? “Life” comes before “liberty” in the Declaration of Independence. Without life, the pursuit of liberty and happiness become nonexistent. Besides, a lot of people are stupid. That’s not very diplomatic, but it’s true. When they need it, people want government to step in and protect them from their mistakes or when they’re at their most vulnerable—then it’s ok, apparently. In addition, people’s “liberty” often adversely affects other people, and everyone would admit that security (in this case, harm minimization) is the government’s role.

You would think that Republicans would be satisfied with the law because it helps big business. Insurance companies, overall, end up the big winners. The ACA is nowhere near nationalized or universal healthcare. That “Romneycare” was the blueprint for “Obamacare” need not be mentioned except to draw attention to the humor and irony involved in the opposition presidential candidate’s contortions around such a personally damaging issue. Hypocrisy at its finest. In fact, Romney, too, notably changed his tune in his speech following the Supreme Court decision which upheld the ACA in its entirety. Romney wants to keep certain provisions in place such as keeping kids on their parents’ insurance until they’re 26, not denying coverage to people with preexisting conditions, and maintaining competition between plans. Some Republican politicians have gone even further to endorse the provision of stopping lifetime caps on care. How to pay for all of this, though, without the mandate? The lynchpin of the law, much like the “automatic trigger” of sequestration enacted after the debt ceiling debates, was put in place to hold people accountable. Otherwise, they will “kick the cab down the road” forever and people will not take responsibility, not individually, and certainly not for the wellbeing of society. The conservatives, who always stress sustainability, have spit in the face of a plan whose central tenet–the individual mandate–they, themselves, designed.

Do they want freedom or security (read: liberty or sustainability)? President Obama’s Democratically passed law provides some measure of both. It aims to address spiraling healthcare costs and provides much choice and increased coverage for millions of people. Almost everyone in the United States is impacted by this law. It is by no means perfect, but it’s a step in the right direction, and if Republicans are still so up in arms about it–and not just because they’re sore losers, hate Obama, aren’t too fond of women, prefer the status quo, and will cling to power at all costs–then it’s a positive sign.

A few days ago, CNN ran a story on historian Niall Ferguson’s take on the fall of the West and the rise of “the rest” (a catchy little term he coined to refer to all of the world that isn’t Europe, the United States and Canada, Australia, New Zealand, and most recently Japan). As he explained on a recent appearance on “The Colbert Report”, the idea of the Western and Eastern blocs, was so 20 years ago. In the post-Cold War period, regions aren’t as clearly defined. The strength of the so-called West in every measurement from greater life expectancy to scientific and technological breakthroughs—and especially in economic output—is very clearly defined, however. Ferguson claims that for the last (approximately) 500 years, the West has been lightyears ahead of the rest. He attributes this rise to 6 “killer apps”, which he says the rest have begun to copy and successfully implement, while the West is simultaneously deleting them. Is Ferguson trying a little too hard to seem cool? Maybe, but he seems to have a point. He has just written a book on the subject, so he’s making the media rounds. If you’re interested, you can check out his quick CNN interview here: http://articles.cnn.com/2011-11-03/opinion/opinion_ferguson-west-economic-decline_1_westerners-chinese-share-global-economy?_s=PM:OPINION

After watching Ferguson declare the fall of Western economic predominance, I felt (understandably) demoralized. The idea that we, as Americans–and, to a larger degree, as so-called Westerners–are the envy of the rest of the world is the kind of ethic that has been ingrained in us from a very early age. Part of this is a kind of not so unique nationalism–every country has its national narrative. Another part of it, though, is based on the truth that the countries of Western Europe (and Oceania), and the United States, in particular, attracted people from all around the world. This region served as a kind of magnet for the dreams and aspirations of people from varying backgrounds. Culturally, the West is definitely still dominant, and probably will continue to be so for years to come. Ferguson mentions Asian shopping malls, but if we take a closer look at fashion, American and European brands and styles dominate the global market. Globalization has even been likened to Americanization on the culture front. Ferguson makes the claim that iPhones are designed in California and made in China, but this is not the way of the world. Really? The West still serves as the place for ideas. The prevalence of Apple copyright infringement in China, for example, is telling. The West is in trouble, though. Following is a list of Ferguson’s “killer apps” (directly quoted from the CNN story):

1. Competition. Europe was politically fragmented into multiple monarchies and republics, which were in turn internally divided into competing corporate entities, among them the ancestors of modern business corporations.

2. The Scientific Revolution. All the major 17th-century breakthroughs in mathematics, astronomy, physics, chemistry and biology happened in Western Europe.

3. The rule of law and representative government. An optimal system of social and political order emerged in the English-speaking world, based on private-property rights and the representation of property owners in elected legislatures.

4. Modern medicine. Nearly all the major 19th- and 20th-century breakthroughs in health care were made by Western Europeans and North Americans.

5. The consumer society. The Industrial Revolution took place where there was both a supply of productivity-enhancing technologies and a demand for more, better and cheaper goods, beginning with cotton garments.

6. The work ethic. Westerners were the first people in the world to combine more extensive and intensive labor with higher savings rates, permitting sustained capital accumulation.

If you’re still reading at this point, I thank you for your patience and your interest. =) I know this a long blog post. I’m going to offer my suggestions on how the United States might strengthen its advantages using Ferguson’s formula. Sure, there are many factors at play, and the US economy is nowhere near being fixed tomorrow, but I thought I’d list some ideas that came to me while writing this.

Competition: Obviously, political circumstances make the advent of investing in innovation difficult right now, and it’s interesting to note that Ferguson does not list “democracy” as one of the “killer apps” that he believes led to half-millennial Western supremacy. He does, however, list competition as one of those apps, citing the fierce competition between early monarchies. European history has also highlighted the large role religious feuds took in shaping societies (Protestants vs. Catholics, anyone?). And what could be more like that than the current situation in Washington? Yay for competing ideologies! This isn’t really a solution, but it’s something of a silver lining the current political morass. Maybe, just maybe, if political competition could then lead to some sort of even limited cooperation, progress could happen within the country. And after that…well, the possibilities are endless!

The Scientific Revolution: This is one of my favorite parts of history because it combines science and a dramatic leap forward in human accomplishment! The Scientific Revolution and the Enlightenment enabled one of those seismic shifts in societal development akin to the evolutionary shift that took place because of the extinction of the dinosaurs. Yes, I love history and science so much I can’t help but use them both in a metaphor. Anyway, the answer to this piece of the puzzle is, perhaps, the most straightforward. Invest in science! We may not have another Scientific Revolution, but the United States has lead on technological innovation from PC development to cybersecurity to nanotechnology and all that other fun Silicon Valley stuff. NASA is still, by far, the most advanced tool we have as human beings to learn about space, and is the symbol of scientific achievement. Many American government-run programs have yielded tremendous advances in science and everyday technology, DARPA being the most well known. Basically, the US should stop cutting NASA’s budget, stop lowering grants to scientists, embrace a serious effort at developing alternative energy technologies (which means not giving up on the entire solar power effort because of what happened with Solyndra), and the government should sponsor more local science exhibitions like the USA Science and Engineering Festival held in Washington, DC. The national festival is fantastic. That model should be replicated. Encouraging science both inside and outside the classroom is all the more important now that NASA has retired the space shuttles and it will be several years before US astronauts launch from Cape Canaveral again.

The Rule of Law and Representative Government: Oh, Locke, this is why the Political Science world loves you, for your incredible contribution to the modern world vis a vis private property rights. I don’t know that much about eminent domain and private property rights, in general, but not foreclosing on the poverty-stricken seems like a positive step. The system of profiting off of people in dire straits is also not only unethical, but not good for the country in the long run. We’d do much to examine the factors of rising economic equality in this country, but back to representative government and the rule of law. Most would agree that the United States’ judicial system is preferable to that of many other countries. While it is far from perfect, and decisions from that in the Casey Anthony trial to the “corporations are people” outcome of Citizens United, sometimes make me question things, I think we should view our system as a strength. The issue of closing the prison at Guantanamo Bay (as well as the myriad of other secret prisons the United States has overseas) has practical implications, but it’s pretty difficult to profess ideals of fairness a model system for the rule of law when indefinite detentions and questionable practices occur in such places. Put simply, it doesn’t make America look very good and it undermines the country’s character and integrity. The United States should also lead on issues of obvious human rights violations, such as the mass killings in Syria, and not just when it serves the country’s interests. Iran has many issues—let’s not only focus on the nuclear aspect. The fact that the country’s leadership grossly abuses human rights should be talked about just as often. Like much of the rest of the Western world, the United States should also abolish the death penalty. There are so many issues pertaining to the death penalty that I would need an entire additional post to scratch the surface of this issue. There are thousands of other reforms that could be made to advance the rule of law. Limiting the amount of money in politics, making races more transparent, and encouraging interest in the political processes are all ways of improving the system of representative government. The electorate is largely uninformed and apathetic. I welcome any suggestions on how remedy this because I think it would serve the interests of all citizens. Sending out clear and concise messages to people (as I mentioned in my first blog post, “Communication is Everything”, could, hopefully sway at least some people to make decisions not to vote against their own interests, a pretty pervasive problem in today’s politics.)

Modern Medicine: Remove barriers to stem cell research! The idea that health care is a necessity—and a right—for all people shouldn’t be a controversial one. Create systems in which insurance companies don’t run the show and medicine and non-emergency care such as mental health and physical therapy treatments are not astronomically unaffordable for people. Much is made about the dangers of modern diets. Organic and vegetarian and vegan options in supermarkets should be subsidized so that being healthy (as well as environmentally conscious) does not have to be an elitist thing, and does not have to belong to only the gentrified or those able to afford the “luxuries” of tofu and vegetables.

The Consumer Society: This extension of this may have led to our undoing. I’m a materialist and I heartily encourage people to spend money. If companies could reinvest more, as opposed to those at the top being so greedy, that would be helpful. The demand for cheap consumer goods coupled with the desire for ever-increasing profit has led to outsourcing and worker abuses. I wish I knew how to fix this problem. I definitely don’t think taking away collective bargaining rights and vilifying unions is the right thing to do, though, and I’m glad that Ohio voted a few hours ago to rectify this.

The Work Ethic: To begin with, I’d like to say that the I think the idea of “welfare queens” and their ilk is terrible myth that has been perpetuated. Most American people work very hard, and receive much shorter vacation periods, benefits, and social programs such as maternity and paternity leave with pay and childcare options, than many of our European counterparts. Even before the recession, raises were dwindling and many people were getting laid off, while career demands became even greater. More burdens and fewer incentives and recognition do not a happy worker make. Unhappy workers equal lower productivity. I think it’s less of an issue of weak work ethic as it is less appreciation for workers that needs to be addressed.

Let’s not write ourselves off yet. There is no reason why our generation can’t be prosperous in an increasingly globalized world. It doesn’t have to be a zero-sum game. Of course, certain things are easier in China with a single party system, government-controlled censorship, and unfailing crackdowns on displays of dissent. That is not a positive model for any country or its people. We can seriously address weaknesses in our system, and strengthen those things that are working. Let us take this moment of crisis and make it into an opportunity.